Provider Demographics
NPI:1467630376
Name:SPARROW, CLARK JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLARK
Middle Name:JOSEPH
Last Name:SPARROW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 YORK AVE
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-2021
Mailing Address - Country:US
Mailing Address - Phone:570-265-3996
Mailing Address - Fax:570-265-3887
Practice Address - Street 1:346 YORK AVE
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-2021
Practice Address - Country:US
Practice Address - Phone:570-265-3996
Practice Address - Fax:570-265-3887
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017754L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice